Back in 1996, the definition and understanding of neuro-rehabilitation was far from how we accept it today. 

Recognised as a life-changing, standalone area of specialist rehabilitation to help patients rebuild their lives from brain and neurological injuries and conditions, neuro-rehab is a crucial and vital component in the lives of countless people around the world. 

But 26 years ago, that was not always the view from everyone. 

As Professor Mike Barnes, founder of the World Federation for Neurorehabilitation (WFNR) recalls, in 1996, neuro-rehab was in its infancy as a recognised area. 

Professor Mike Barnes

“I thought that neuro-rehabilitation needed a clearer voice so we could gain more credibility and coherence in sometimes, to be frank, a neurological environment that was rather hostile to the concept of neurology helping to rehabilitate people,” says Professor Barnes. 

But now, through the efforts of professionals throughout the world to unite and gain recognition for neuro-rehabilitation, the situation is vastly different. 

A respected discipline globally, with its practice based solidly on research and science, the significant strides the specialism has made are due in no small part to the creation of the WFNR, which, for the first time, brought together the many disciplines now recognised as being part of neuro-rehabilitation around the world.

With over 5,000 members internationally and 37 special interest groups (SIGs), the WFNR is now affiliated to 42 National Societies globally – demonstrating the national reach and unifying role the organisation has had in its two and a half decades in existence. 

It is also recognised by the World Health Organisation, with the WHO’s Rehabilitation 2030 document highlighting the importance of neurorehabilitation, and its Flying Faculty programme to deliver neurorehab training around the world – particularly middle and lower-income countries – helping to effect deep-rooted change. 

“I think our original aim has been met – to create a global organisation bringing together health professionals with an interest in neurorehabilitation,” says Professor Barnes. 

“It is now a recognised and respected sub-speciality of neurology. Gone – I hope – are the days when practising in neurorehab was considered beneath the neurology community. 

“We now serve our patients much better than we used to and I think the WFNR has played a major role in that change.”

For Professor David Good, president of WFNR who part of the organisation for over 20 years has been, the adoption of scientific-based practice within therapies helped to give neuro-rehabilitation the standing it has today. 

“I didn’t really think (25 years ago) there was much science that has been applied to the field of rehabilitation in general. I agree with Mike that neuro-rehabilitation was a bit of a stepchild or was not really accepted so much within neurology,” says Professor Good.

“I will say that, compared to some other areas in neurology, for example epilepsy or Parkinson’s disease or multiple sclerosis, probably neurorehab has not quite reached that level of acceptance. 

“But certainly I’ve seen a great deal of science now, that’s been injected into neurorehab. That was not seen when I first started. Things like physiotherapy and occupational therapy and speech therapy are more based in science. They have science they can rely on, that they can adopt into their everyday practice.”

The journey to this point has not been dictated by one major event, but a “series of evolutions,” says Professor Good, an internationally-renowned stroke specialist and chair of neurology at Penn State University. 

“It’s really been a gradual path, but with many things along the way, such as the development of the Flying Faculty. One of our goals in general, has been to promote neurorehab to low and middle-income countries, there’s a huge demand. And this was one way to bring a rehab to some of those countries. 

“More recently, our involvement with the World Health Organisation, and some of their efforts to develop neurology and rehabilitation worldwide, has been a great positive. I think that’s a good example of how we have been accepted worldwide. 

“I’m also very proud of the educational efforts of WFNR, and there are many facets to that.”

Professor David Good

Education and awareness are something very close to the heart of all at WFNR, especially in lower and middle-income countries, with the rise of telemedicine during the pandemic enabling people around the world to benefit from the surge in remote access to support. 

“For example, the incidence of stroke has gone up 180 per cent in the last nine years, and the major burden is in low- and middle-income countries. And yet these countries have virtually no neuro-rehabilitation, very few physicians, very few physiotherapists, speech therapists,” he says. 

“So the demand far outstrips the reality of service delivery. But one of the positive things, if there is anything, about the pandemic, has been the growth of the growth of telemedicine, virtual rehabilitation.

“This is something that was developing anyway, but with the COVID pandemic, the need for remote rehabilitation has just skyrocketed. 

“And it’s been, I think, a real advantage. There’s some criticism about, for example, the fact a lot of rehab is hands on, but there’s much that can be done remotely as well. 

“I’m excited about it and I think we’ve changed things permanently to some extent that remote medicine and remote rehabilitation will be with us in the future as well.”

And alongside the growth of telemedicine, other technologies are coming to the fore in a fast-growing and changing neuro-rehabilitation sector, which has moved on beyond recognition in the 25 years of WFNR’s existence and hold huge potential for the continued progress of neuro-rehab. 

“There’s a lot of technology that’s been developed for neuro-rehabilitation. Is all of it going to be useful in the future? We don’t know yet,” he says. 

“For example, robotics, when you review the literature, it’s a little bit vague as to whether robotics is helpful, but I do think there are some real possibilities there. 

“Another form of technology that’s really exciting is the brain/machine interface.  For people who have had a stroke and cannot speak, for children with advanced cerebral palsy, it can be incredible. I’ve seen some incredible videos of children who are quadriplegic, they can’t walk, they can’t propel a wheelchair – but by using brain computer interface and taking EEG signals, they learn how to propel a wheelchair and can zip all over the place. 

“I think there in particular there is real, real hope for the future. It involves a tremendous amount of engineering to decode these signals and create actual movements or speech from them, so it’s work in progress, but I think it’s very exciting stuff.

“Cell Transplantation is another technology that perhaps might be useful. There have been some recent articles that suggest that cell transplant patient in patients who have motor deficits might be beneficial, but that’s potentially invasive. But if you could do it non-invasively, that’s great. 

“AI is another technology which holds huge promise for the future, although I must claim a bit of ignorance myself here, although my colleagues tell me it is a great area of potential. 

“If you think back to when WFNR was created, when there was no science, now we’re getting all these exciting developments, which open all sorts of doors. Now, we can help disseminate this information not only to our members, but to the neuro-rehab community at large throughout the world. And that’s a major goal of ours, too.”

* The 12th World Congress for Neuro-rehabilitation is to be held in Vienna from 14-17 December. For more details, visit here